Syringe Confiscation as an HIV Risk Factor: the Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico
Journal of Urban Health, Vol. 90, No. 2, pp. 284-298, 2013
Posted: 12 May 2012 Last revised: 1 Apr 2013
Date Written: May 10, 2012
Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over-the-counter without a prescription, but police practices are often at odds with the law. FSW-IDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48%. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR]=2.54, 95% confidence interval [CI]=1.11-5.80), reporting sexual abuse by police (aOR=12.76, 95%CI=6.58-24.72), engaging in groin injection (aOR=1.84, 95%CI=1.15-2.93), injecting in public (aOR=1.64; 95%CI=1.14-2.36), and obtaining syringes from pharmacies (aOR:1.54; 95%CI=1.06-2.23). Higher education level was negatively associated with syringe confiscation (aOR=0.92, 95%CI=0.87-0.98) as was frequent injection with clients within the last month (aOR=0.64, 95%CI=0.44-0.94). This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.
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